Archive for September, 2009

In today’s increasingly complex health care environment, with a rapidly proliferating capacity to provide effective, but complicated care, there is an associated increased risk to the patients we serve. Patient care, in almost any setting, is an inherently hazardous endeavor. Since the sentinel IOM report, To Err Is Human, was published, there has been an increasing focus on addressing safety.

“The truth is, we never know for sure about ourselves…only after we’ve done a thing do we know what we’ll do…Which is why we have spouses and children and parents and colleagues and friends, because someone has to know us better than we know ourselves.” Richard Russo, Straight Man: A Novel

“You are allowed to think that adult life consists of a constant exercise of personal will; but it wasn’t really like that, Jean thought. You do things, and only later do you see why you did them, if ever you do.” Julian Barnes, Staring at the Sun

In more than 25 years of medical practice, I was frustrated by the frequent non-compliance of my patients. Despite my best exhortations and lengthy explanations, I was astonished and disappointed by the limited impact I had on addressing the needed behavior changes to ensure a healthier patient population. It would have made my life much simpler if those patients had only listened to my sage advice.

I spent a delightful weekend facilitating the Medical Staff/Board Retreat for St. Mary’s Hospital in Grand Junction, CO. I was pleased to be asked to come to Grand Junction because like Minnesota, this community is clearly the anti-McAllen, TX when it comes to providing high-quality, low-cost health care. In fact, my hosts had just had visits from both President Obama and a medical delegation from McAllen.

As we attempt to implement the recommendations of the IOM report, Crossing the Quality Chasm, the focus on patient-centered care has sharpened. The evolving medical/health care home concept has direct implications for the need to have a fully engaged patient and family if there is to be a successful transformation of the way health care is delivered in our country.

Ever since I got interested in how people get jobs through weak connections with acquaintances and not close friends and relatives as described years ago by Granovetter, network theory has fascinated me. The Kevin Bacon Game was one of my favorites until researchers discovered that Kevin Bacon was not the most connected actor in Hollywood movies. The whole subject became even more relevant, of course, with the Internet and social media.

The PCMH (patient-centered medical home) is a concept which is being touted as the predominant change vehicle for potentially transforming the health care system. It is estimated that 46 of the 50 states now have some type of “medical home pilot” initiative underway. Certainly here in Minnesota, with state legislative mandates for health care reform, ICSI’s history with the DIAMOND initiative and our work on health care home, the dialogue and enthusiasm, sprinkled with a bit of skepticism, have built a buzz for advancing this concept.

Any rational, well-informed person knows that the status quo of the American health care system is not financially sustainable, does not produce outcomes as good as other countries that spend a lot less money, does not give medical care access to about 50 million Americans, causes about 700,000 bankruptcies every year, and is a major cause of American companies struggling to be successful in an increasingly global economy.